Black cohosh and other herbal remedies associated with acute hepatitis

Whiting, P.; Clouston, Andrew D.; Kerlin, Paul

doi:10.5694/j.1326-5377.2002.tb04886.x

Cited by 144 publications

(66 citation statements)

References 29 publications

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“…[3][4][5] We submit that our patient represents the fifth case. Using the Council of International Organisations of Medical Sciences (CIOMS) classification system (called Roussel Uclaf Causality Assessment Method (RUCAM)), this case has a score of 6, which suggests probable adverse drug reaction.…”

Section: Discussionmentioning

confidence: 91%

Subacute liver failure secondary to black cohosh leading to liver transplantation

et al. 2013

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The use of herbal medications is increasing significantly in the UK and there is a perception that herbal preparations are without adverse effects. This case report highlights the potential risks of black cohosh, which is one of the most commonly used herbal products. This is a case report of a 60-year-old Caucasian lady who presented with subacute liver failure secondary to taking black cohosh. This was further confirmed by liver biopsy and she subsequently deteriorated and underwent liver transplantation. Available evidence supports an association between black cohosh and risk of hepatotoxicity. In current literature, there have only been four previously reported cases of hepatotoxicity associated with black cohosh, which required liver transplantation. We submit that our patient represents the fifth case. We recommend that patients taking this supplement should have close monitoring of their hepatic function, especially in the presence of other risk factors.

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Section: Discussionmentioning

confidence: 91%

Subacute liver failure secondary to black cohosh leading to liver transplantation

et al. 2013

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“…The incidence of hepatotoxicity from herbal remedies has been estimated at 0.2% to 1%, the true incidence is unknown due to a lack of prospective trial data 5. The mechanisms causing hepatotoxicity are poorly understood, drug toxicity to the liver can manifest as any liver disorder (eg, hepatitis, cholangitis, cholestasis) with acute hepatitis occurring in 90% of cases 45…”

Section: Discussionmentioning

confidence: 99%

“…There have been few prospective randomised control trials to date raising the concern that present data may not highlight potential adverse effects. Information documenting adverse reactions is currently based on case reports and review articles 5. As the use of herbal medicines increases, a number of idiosyncratic hepatotoxic reactions to herbal medicines have been reported (table 1).…”

Section: Introductionmentioning

confidence: 99%

Acute liver injury associated with the use of herbal preparations containing glucosamine: three case studies

Smith

Dillon²

2009

Case Reports

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The use of complementary and alternative medicines is becoming increasingly popular in Western society. As a result the number of reported adverse reactions is increasing. Glucosamine is a herbal remedy commonly used to ease joint pain in osteoarthritis, and only two previous reports of hepatotoxicity have been published in the scientific literature. The present report describes three patients who developed acute liver injury following exposure to glucosamine; one patient made a complete recovery on cessation of ingestion, the second developed chronic hepatitis and the third died following progression to fulminant hepatic failure. A diagnosis of glucosamine-induced hepatotoxicity was made based on the temporal relationship between onset of liver injury and glucosamine ingestion, exclusion of all other potential aetiologies and, in the two surviving cases, improvement in condition on withdrawal of the supplement.

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“…There have been a handful of case reports linking black cohosh to liver damage (Levitsky et al 2005, Cohen et al 2004, Lontos et al 2003, Whiting et al 2002), (reviews in (Thomsen et al 2004, Huntley, 2004, Huntley and Ernst, 2003)). Conclusions from these case reports were confounded by the lack of details reported, for example, dose, source, and preparation of black cohosh.…”

Section: Discussionmentioning

confidence: 99%

Black Cohosh: Insights into its Mechanism(s) of Action

Ruhlen

Sun

Sauter

2008

Integr Med�Insights

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The Women's Health Initiative found that combination estrogen and progesterone hormone replacement therapy increases breast cancer and cardiovascular disease risk, which compelled many women to seek herbal alternatives such as black cohosh extract (BCE) to relieve their menopausal symptoms. While several clinical trials document the effi cacy of BCE in alleviating menopausal symptoms, preclinical studies to determine how BCE works have yielded confl icting results. Part of this is because there is not a universally accepted method to standardize the dose of black cohosh triterpenes, the presumed active ingredients in the extract. Although the mechanism by which BCE relieves symptoms is unknown, several hypotheses have been proposed: it acts 1) as a selective estrogen receptor modulator, 2) through serotonergic pathways, 3) as an antioxidant, or 4) on infl ammatory pathways. We found that while the most prominent triterpene in BCE, 23-epi-26-deoxyactein, suppresses cytokine-induced nitric oxide production in brain microglial cells, the whole BCE extract actually enhanced this pathway. A variety of activities have been reported for black cohosh and its compounds, but the absorption and tissue distribution of these compounds is unknown.

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Black cohosh and other herbal remedies associated with acute hepatitis

Cited by 144 publications

References 29 publications

Subacute liver failure secondary to black cohosh leading to liver transplantation

Subacute liver failure secondary to black cohosh leading to liver transplantation

Acute liver injury associated with the use of herbal preparations containing glucosamine: three case studies

Black Cohosh: Insights into its Mechanism(s) of Action

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